Health Information Management

Answer appropriate questions before billing for IV antibiotics and dressing change

APCs Insider, August 3, 2007

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QUESTION: I have a question regarding an article in the June 1, 2007 issue of the APCs Weekly Monitor titled "Do not bill E/M with drug administration charge when an infusion is the sole reason for the visit". I understand the question and answer given in this issue but would like to ask a related question. We sometimes have patients that present for IV antibiotics and a dressing change. We scheduled both services, and we charge for the infusion, but we are not sure whether to charge for the dressing change. Sometimes this procedure can entail a considerable amount of nursing work and time, as well as supply costs, and there isn't a code for dressing changes. Would this be a time when we could report a level one E/M charge (99211) for the facility, using revenue code 761 for the treatment room?

ANSWER: Your scenario mentions that the patient is scheduled for both an infusion and dressing change. You must answer several questions to determine whether you should report an E/M visit charge with modifier -25 in addition to the infusion charge. These questions include the following:

1. Are there two physician orders-one for the infusion and another for the dressing change? A specific physician order is one indicator of a significant and separately identifiable service.

2. Are there separate indications or diagnoses for the two treatments, and is the dressing change performed on an entirely separate area from the infusion site? In other words, is it logical that the dressing change is in no way related to the infusion?

3. Are both treatments appropriately documented?

If the answers to all three questions are yes, then follow your E/M visit guidelines to assign a clinic visit level to the dressing change. Do not limit yourself to code 99211. Instead, base the choice of visit level on the documentation and your clinic guidelines. Finally, determine whether to use revenue code 510 or 761 based on the treatment area and your payer and billing practices.

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